Correspondence

Thalidomide for Malignant Melanoma

N Engl J Med 2001; 345:1214-1215October 18, 2001

Article

To the Editor:

A 63-year-old man with a dense left hemiplegia from a stroke two and a half years earlier was seen in the clinic in May 2000 with clinical evidence of relapsed malignant melanoma of the scalp. Stage II malignant melanoma over the vertex had first been diagnosed in March 1999. In July 1999, the lesion was widely excised, with a 1-cm margin of normal tissue. The diameter of the melanoma was 1 cm and its depth 4 mm. The margin was tumor-free. He received no adjuvant therapy. In March 2000, two lesions developed, one measuring 10 by 8 mm over the right parietal region and the other measuring 4 by 4 mm over the scalp and forehead in the midline; each was accompanied by three satellite nodules measuring 2 by 2 mm. He was not considered to be a candidate for aggressive therapy and was referred to us for a second opinion in May 2000. A fine-needle aspiration biopsy confirmed the presence of recurrent malignant melanoma (Figure 1Figure 1Single, Discohesive Malignant Melanoma Cells (Modified Wright–Giemsa Stain, ×600).), with the cells staining positive for the antigens S-100 and HMB-45. The lesions were judged to be in-transit metastases, since they were both more than 2 cm away from the site of the primary lesion. Imaging studies confirmed that the disease was localized to the scalp.

The patient was mentally sound but required a wheelchair on account of his hemiplegia. He also had a tonic–clonic seizure disorder as a result of his stroke. He was not believed to be a candidate for aggressive surgery, chemotherapy, or immunotherapy. He was given a four-week trial of immunotherapy consisting of twice-weekly perilesional injections of bacille Calmette–Guérin; there was no local response, and the tumor progressed. He was then empirically treated with 200 mg of thalidomide daily. Within six weeks, the lesions had shrunk substantially, and after six months they had resolved completely. Confirmatory skin biopsies revealed only scar tissue. Imaging studies showed no disease elsewhere. Currently, the patient remains in complete remission while receiving thalidomide, although the dose has been reduced (to 100 mg) because of constipation.

Thalidomide has been used in clinical trials to treat advanced malignant melanoma, with some evidence of a response.1-3 In this patient, we observed a complete response with the use of thalidomide alone. The sequence of events in this case makes both spontaneous remission and a response to the vaccination with bacille Calmette–Guérin extremely unlikely.

Ganesh C. Kudva, M.D.
Brian T. Collins, M.D.
Frank R. Dunphy, II, M.D.
Saint Louis University School of Medicine, St. Louis, MO 63110-0250
gckudva@yahoo.com

3 References

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   Eisen T, Boshoff C, Mak I, et al. Continuous low dose thalidomide:a phase II study in advanced melanoma, renal cell, ovarian and breast cancer. Br J Cancer 2000;82:812-817
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   Eisen TG. Thalidomide in solid tumors: the London experience. Oncology (Huntingt) 2000;14:Suppl 13:17-20
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   Hwu WJ. New approaches in the treatment of metastatic melanoma: thalidomide and temozolamide. Oncology (Huntingt) 2000;14:Suppl 13:25-28
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Citing Articles (5)

Citing Articles

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   Joseph I. Clark, James Moon, Laura F. Hutchins, Jeffrey A. Sosman, W. Martin Kast, Diane M. Da Silva, P. Y. Liu, John A. Thompson, Lawrence E. Flaherty, Vernon K. Sondak. (2010) Phase 2 trial of combination thalidomide plus temozolomide in patients with metastatic malignant melanoma: Southwest Oncology Group S0508. Cancer 116:2, 424-431
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2. 2

   Abu Shadat M. Noman, Naoki Koide, Imtiaz I.-E. Khuda, Jargalsaikhan Dagvadorj, Gantsetseg Tumurkhuu, Yoshikazu Naiki, Takayuki Komatsu, Tomoaki Yoshida, Takashi Yokochi. (2008) Thalidomide inhibits epidermal growth factor-induced cell growth in mouse and human monocytic leukemia cells via Ras inactivation. Biochemical and Biophysical Research Communications 374:4, 683-687
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3. 3

   Laura F. Hutchins, James Moon, Joseph I. Clark, John A. Thompson, Marianne K. Lange, Lawrence E. Flaherty, Vernon K. Sondak. (2007) Evaluation of interferon alpha-2B and thalidomide in patients with disseminated malignant melanoma, phase 2, SWOG 0026. Cancer 110:10, 2269-2275
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   S. N. Markovic, L. A. Erickson, R. D. Rao, R. H. Weenig, B. A. Pockaj, A. Bardia, C. M. Vachon, S. E. Schild, R. R. McWilliams, J. L. Hand, S. D. Laman, L. A. Kottschade, W. J. Maples, M. R. Pittelkow, J. S. Pulido, J. D. Cameron, E. T. Creagan, . (2007) Malignant Melanoma in the 21st Century, Part 2: Staging, Prognosis, and Treatment. Mayo Clinic Proceedings 82:4, 490-513
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5. 5

   Emilio Bajetta, Michele Del Vecchio, Chantal Bernard-Marty, Milena Vitali, Roberto Buzzoni, Olivier Rixe, Paola Nova, Stefania Aglione, Sophie Taillibert, David Khayat. (2002) Metastatic melanoma: Chemotherapy. Seminars in Oncology 29:5, 427-445
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